AHIP 2026 CERTIFICATION EXAM
QUESTIONS & A+ ALREADY GRADED
ANSWERS
Edward suffered from serious kidney disease. As a result, Edward became eligible for Medicare
coverage due to end-stage renal disease (ESRD). A close relative donated their kidney and
Edward successfully underwent transplant surgery 12 months ago. Edward is now age 50 and
asks you if his Medicare coverage will continue, what should you say?
Ms. Henderson believes that she will qualify for Medicare Coverage when she turns 65, without
paying any premiums, because she has been working for 40 years and paying Medicare taxes.
What should you tell her?
To obtain Part B coverage, she must pay a standard monthly premium, though it is higher for
individuals with higher incomes.
Ms. Lewis has aggressive cancer and would like to know if Medicare will cover hospice services
in case she needs them. What should you tell her?
Medicare covers hospice services under Part A.
Mr. Capadona would like to purchase a Medicare Advantage (MA) plan and a Medigap plan to
pick up costs not covered by that plan. What should you tell him?
It is illegal for you to sell Mr. Capadona a Medigap plan if he is enrolled in an MA plan, and
besides, Medigap only works with Original Medicare.
Mr. Vasquez is in good health and is preparing a budget in anticipation of his retirement when
he turns 66. He wants to understand the health care costs he might be exposed to under
Medicare if he were to require hospitalization because of an illness. In general terms, what
could you tell him about his costs for inpatient hospital services under Original Medicare?
Under Original Medicare, there is a single deductible amount due for the first 60 days of any
inpatient hospital stay, after which it converts into a per-day amount through day 90. After day
90, he would pay a daily amount up to 60 days over his lifetime, after which he would be
responsible for all costs
Mrs. Foster is covered by Original Medicare. She sustained a hip fracture and is being
successfully treated for that condition. However, she and her physicians feel that after her
,lengthy hospital stay, she will need a month or two of nursing and rehabilitative care. What
should you tell them about Original Medicare's coverage of care in a skilled nursing facility?
Medicare will cover Mrs. Foster's skilled nursing services provided during the first 20 days of her
stay, after which she would have a copay until she has been in the facility for 100 days.
Mr. Wu is eligible for Medicare. He has limited financial resources but failed to qualify for the
Part D low-income subsidy. Where might he turn for help with his prescription drug costs?
Mr. Wu may still qualify for help in paying Part D costs through his State Pharmaceutical
Assistance Program (SPAP).
Mr. Singh would like drug coverage but does not want to be enrolled in a Medicare Advantage
plan. What should you tell him?
Mr. Singh can enroll in a stand-alone prescription drug plan and continue to be covered for Part
A and Part B services through Original Fee-for-Service Medicare.
Mr. Schmidt would like to plan for retirement and has asked you what is covered under Original
Fee-for-Service (FFS) Medicare. What could you tell him?
Part A, which covers hospital, skilled nursing facility, hospice, and home health services and Part
B, which covers professional services such as those provided by a doctor are covered under
Original Medicare.
Anthony Boniface turned 65 in 2024. He was not receiving Social Security or Railroad
Retirement Benefits on his 65th birthday. He was interested in obtaining Medicare coverage and
is eligible for premium-free Part A. Before he could enroll in Medicare, his entire area was
impacted by a hurricane causing massive flooding and severe wind damage. The Federal
government declared this to be a natural disaster which has recently ended. During this period
Anthony's initial enrollment period expired. Anthony asks you how he can now obtain Medicare
coverage. What should you say?
Anthony is eligible for a SEP of six months after the end of the disaster declaration. Use of the
SEP will allow Anthony to sign up for Part B without being subject to a Part B late penalty.
Anthony may enroll in premium-free Part A at any time and his Part A coverage will be
retroactive for up to 6 months.
Ms. Kumar plans to retire when she turns 65 in a few months. She is in excellent health and will
have considerable income when she retires. She is concerned that her income will make it
impossible for her to qualify for Medicare. What could you tell her to address her concern?
, Medicare is a program for people age 65 or older and those under age 65 with certain
disabilities, end-stage renal disease, and Lou Gehrig's disease so she will be eligible for
Medicare.
Juan Perez, who is turning age 65 next month, intends to work for several more years at
Smallcap, Incorporated. Smallcap has a workforce of 15 employees and offers employer-
sponsored healthcare coverage. Juan is a naturalized citizen and has contributed to the
Medicare system for over 20 years. Juan asks you if he will be entitled to Medicare and if he
enrolls how that will impact his employer- sponsored healthcare coverage. How would you
respond?
Juan is likely to be eligible for Medicare once he turns age 65 and if he enrolls Medicare would
become the primary payor of his healthcare claims and Smallcap does not have to continue to
offer him coverage comparable to those under age 65 under its employer-sponsored group
health plan.
Mrs. Ellis recently turned 66 and decided after many years of work to retire and begin receiving
Social Security benefits. Shortly thereafter Mrs. Ellis received a letter informing her that she had
been automatically enrolled in Medicare Part B. She wants to understand what this means.
What should you tell Mrs. Ellis?
Part B primarily covers physician services. She will be paying a monthly premium and, with the
exception of many preventive and screening tests, generally will have 20% coinsurance for these
services, in addition to an annual deductible.
Mrs. Cook is an elderly retiree. Mrs. Cook has a low fixed income. What could you tell Mrs. Cook
that might be of assistance?
She should contact her state Medicaid agency to see if she qualifies for one of several programs
that can help with Medicare costs for which she is responsible.
Mrs. Thomas is 66 years old, has coverage under an employer plan, and will retire next year. She
heard she must enroll in Part B at the beginning of the year to ensure no gap in coverage. What
can you tell her?
Individuals covered under an employer's plan may enroll in Part B at any time. If an individual
retires, they will be able to enroll in Part B during a special enrollment period that lasts 8
months following the last month of her employer coverage.
Agent John Miller is meeting with Jerry Smith, a new prospect. Jerry is currently enrolled in
Medicare Parts A and B. Jerry has also purchased a Medicare Supplement (Medigap) plan which
he has had for several years. However, the plan does not provide drug benefits. How would you
advise Agent John Miller to proceed?
QUESTIONS & A+ ALREADY GRADED
ANSWERS
Edward suffered from serious kidney disease. As a result, Edward became eligible for Medicare
coverage due to end-stage renal disease (ESRD). A close relative donated their kidney and
Edward successfully underwent transplant surgery 12 months ago. Edward is now age 50 and
asks you if his Medicare coverage will continue, what should you say?
Ms. Henderson believes that she will qualify for Medicare Coverage when she turns 65, without
paying any premiums, because she has been working for 40 years and paying Medicare taxes.
What should you tell her?
To obtain Part B coverage, she must pay a standard monthly premium, though it is higher for
individuals with higher incomes.
Ms. Lewis has aggressive cancer and would like to know if Medicare will cover hospice services
in case she needs them. What should you tell her?
Medicare covers hospice services under Part A.
Mr. Capadona would like to purchase a Medicare Advantage (MA) plan and a Medigap plan to
pick up costs not covered by that plan. What should you tell him?
It is illegal for you to sell Mr. Capadona a Medigap plan if he is enrolled in an MA plan, and
besides, Medigap only works with Original Medicare.
Mr. Vasquez is in good health and is preparing a budget in anticipation of his retirement when
he turns 66. He wants to understand the health care costs he might be exposed to under
Medicare if he were to require hospitalization because of an illness. In general terms, what
could you tell him about his costs for inpatient hospital services under Original Medicare?
Under Original Medicare, there is a single deductible amount due for the first 60 days of any
inpatient hospital stay, after which it converts into a per-day amount through day 90. After day
90, he would pay a daily amount up to 60 days over his lifetime, after which he would be
responsible for all costs
Mrs. Foster is covered by Original Medicare. She sustained a hip fracture and is being
successfully treated for that condition. However, she and her physicians feel that after her
,lengthy hospital stay, she will need a month or two of nursing and rehabilitative care. What
should you tell them about Original Medicare's coverage of care in a skilled nursing facility?
Medicare will cover Mrs. Foster's skilled nursing services provided during the first 20 days of her
stay, after which she would have a copay until she has been in the facility for 100 days.
Mr. Wu is eligible for Medicare. He has limited financial resources but failed to qualify for the
Part D low-income subsidy. Where might he turn for help with his prescription drug costs?
Mr. Wu may still qualify for help in paying Part D costs through his State Pharmaceutical
Assistance Program (SPAP).
Mr. Singh would like drug coverage but does not want to be enrolled in a Medicare Advantage
plan. What should you tell him?
Mr. Singh can enroll in a stand-alone prescription drug plan and continue to be covered for Part
A and Part B services through Original Fee-for-Service Medicare.
Mr. Schmidt would like to plan for retirement and has asked you what is covered under Original
Fee-for-Service (FFS) Medicare. What could you tell him?
Part A, which covers hospital, skilled nursing facility, hospice, and home health services and Part
B, which covers professional services such as those provided by a doctor are covered under
Original Medicare.
Anthony Boniface turned 65 in 2024. He was not receiving Social Security or Railroad
Retirement Benefits on his 65th birthday. He was interested in obtaining Medicare coverage and
is eligible for premium-free Part A. Before he could enroll in Medicare, his entire area was
impacted by a hurricane causing massive flooding and severe wind damage. The Federal
government declared this to be a natural disaster which has recently ended. During this period
Anthony's initial enrollment period expired. Anthony asks you how he can now obtain Medicare
coverage. What should you say?
Anthony is eligible for a SEP of six months after the end of the disaster declaration. Use of the
SEP will allow Anthony to sign up for Part B without being subject to a Part B late penalty.
Anthony may enroll in premium-free Part A at any time and his Part A coverage will be
retroactive for up to 6 months.
Ms. Kumar plans to retire when she turns 65 in a few months. She is in excellent health and will
have considerable income when she retires. She is concerned that her income will make it
impossible for her to qualify for Medicare. What could you tell her to address her concern?
, Medicare is a program for people age 65 or older and those under age 65 with certain
disabilities, end-stage renal disease, and Lou Gehrig's disease so she will be eligible for
Medicare.
Juan Perez, who is turning age 65 next month, intends to work for several more years at
Smallcap, Incorporated. Smallcap has a workforce of 15 employees and offers employer-
sponsored healthcare coverage. Juan is a naturalized citizen and has contributed to the
Medicare system for over 20 years. Juan asks you if he will be entitled to Medicare and if he
enrolls how that will impact his employer- sponsored healthcare coverage. How would you
respond?
Juan is likely to be eligible for Medicare once he turns age 65 and if he enrolls Medicare would
become the primary payor of his healthcare claims and Smallcap does not have to continue to
offer him coverage comparable to those under age 65 under its employer-sponsored group
health plan.
Mrs. Ellis recently turned 66 and decided after many years of work to retire and begin receiving
Social Security benefits. Shortly thereafter Mrs. Ellis received a letter informing her that she had
been automatically enrolled in Medicare Part B. She wants to understand what this means.
What should you tell Mrs. Ellis?
Part B primarily covers physician services. She will be paying a monthly premium and, with the
exception of many preventive and screening tests, generally will have 20% coinsurance for these
services, in addition to an annual deductible.
Mrs. Cook is an elderly retiree. Mrs. Cook has a low fixed income. What could you tell Mrs. Cook
that might be of assistance?
She should contact her state Medicaid agency to see if she qualifies for one of several programs
that can help with Medicare costs for which she is responsible.
Mrs. Thomas is 66 years old, has coverage under an employer plan, and will retire next year. She
heard she must enroll in Part B at the beginning of the year to ensure no gap in coverage. What
can you tell her?
Individuals covered under an employer's plan may enroll in Part B at any time. If an individual
retires, they will be able to enroll in Part B during a special enrollment period that lasts 8
months following the last month of her employer coverage.
Agent John Miller is meeting with Jerry Smith, a new prospect. Jerry is currently enrolled in
Medicare Parts A and B. Jerry has also purchased a Medicare Supplement (Medigap) plan which
he has had for several years. However, the plan does not provide drug benefits. How would you
advise Agent John Miller to proceed?
